Provider Demographics
NPI:1649555004
Name:MYMICHIGAN MEDICAL CENTER TAWAS
Entity type:Organization
Organization Name:MYMICHIGAN MEDICAL CENTER TAWAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER PATIENT ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEIRCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-356-7597
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-6426
Mailing Address - Fax:989-362-6527
Practice Address - Street 1:325 E M 55
Practice Address - Street 2:SUITE B
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-8211
Practice Address - Country:US
Practice Address - Phone:989-362-6426
Practice Address - Fax:989-362-6527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOC56002Medicare Oscar/Certification